改良阴式非脱垂子宫切除术临床体会

目的:探讨经阴道非脱垂子宫切除术的术式技巧和临床效果。方法:对70例非脱垂子宫行改良式经阴道切除术(a-TVH),与同期指征相近的60例经腹子宫切除术(TAH)进行比较。结果:按a-TVH的手术要点,安全地经阴道切除16孕周大小非脱垂子宫,未损伤邻近器官。子宫≤ 12孕周者,a-TVH组手术时间为(66.41±19.56)min,显著短于TAH组的(78.40±22.28)min(P<0.01);a-TVH组术中出血量为(86.20±21.21)ml,显著低于TAH组的(100.51±18.34)ml(P<0.01)。子宫>12孕周者,两组手术时间和术中出血量差异均无统计学意义(P>0.05)。a-TVH组术后肛门排气时间(28.24±4.23)h、术后下床活动时间(27.25±2.56)h、术后住院时间(5±1.2)天、术后镇痛率7.14%和术后体温升高率5.71%,TAH组术后肛门排气时间(39.25±3.44)h、术后下床活动时间(36.13±3.52)h、术后住院时间(7±1.3)天、术后镇痛率85.00%和术后体温升高率25%,两组差异有统计学意义(P<0.01)。结论:a-TVH损伤小,术后患者恢复快。子宫良性疾病、无明显盆腔粘连、子宫≤ 16孕周大小者可首选阴式子宫切除术。

Improved vaginal hysterectomy for non-prolapsed uterus

Objective： To assess the technique and clinical effect of improved transvaginal hysterectomy （TVH）for non-prolapsed uterus. Methods ： Seventy cases of non-prolapsed uterus were performed the improved transvaginal hysterectomy （ a-TVH ） and the other 60 cases transabdominal hysterectomy（TAH）. The outcome was compared. Results：The non-prolapsed uterus with the size of 16 weeks of gestation was safely removed by a-TAH, with no damage to the adjacent organs. For the cases with the uterus size ≤12 weeks of gestation,the average operation time was （ 66.41 ± 19.56 ） min and （78.40± 22.28 ） min in the a-TVH group and TAH group, respectively （P 〈 0.01 ）. The average volume of blood loss was （86.20± 21.21 ） ml and （ 100.51± 18.34 ） ml in a-TVH group and TAH group,respectively （P 〈 0.01 ）. For the cases with the uterus size 〉 12 weeks of gestation, there was no significant difference in the average operation time or the average volume of blood loss between the two groups （ P 〉 0.05 ）. In the TVH group, the anus exhaust time was （28.24 ± 4.23 ）h and the first time to move about was （27.25 ± 2.56）h after the operation;postoperative pain was observed in 7.14% of the patients and the incidence of fever was 5.71% ;the average hospital stay was （5 ± 1.2）d after the operation. In the TAH group,the anus exhaust time was （39.25 ±3.44）h and the first time to move about was （36.13 ± 3.52）h after the operation; 85.00% of the patients complained of postoperative pain and 25% of the patients developed fever;the average hospital stay was （7 ± 1.3）d after the operation. The difference was significant （P 〈 0.01 ）. Conclusions： a-TVH is a good operative method with the advantages of less damage and quicker recovery. For cases of benign disease of the uterus, non serious pelvic adherence or bulk of the uterus ≤ 16 weeks of gestation,the TVH is the first choice.